Pharmacist Clinical
Core
Manages pharmaceutical selection and clinical utilization management programs including prior authorization, step therapy, and quantity limitations to ensure appropriate, cost-effective drug therapy.
Role type
Senior IC clinical pharmacist (utilization management)
Builds
Clinical criteria, drug monographs, and point-of-sale edits for pharmacy and medical benefits
Domain
Health insurance / Pharmacy benefit management (PBM)
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
Clinical data synthesis, therapeutic class review, drug monograph preparation, DUR (Drug Utilization Review) management, clinical criteria development, evidence-based guideline application, claims system configuration, stakeholder collaboration
Preferred skills
PharmD degree, P&T committee experience, Medi-Span database proficiency, cross-mapping clinical codes, drug-utilization screening rule optimization
Technologies
Medi-Span database, claims systems, clinical review algorithms
Responsibilities
Research and synthesize clinical data related to pharmaceuticals; Prepare and present therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics Committee; Lead development and maintenance of clinical criteria for drugs; Review clinical evidence to create utilization management edits; Ensure compliance of pharmacy utilization management edits with state and federal mandates; Provide drug information support to internal stakeholders
Seniority
Mid-Senior level, hands-on IC